Chirlane McCray: We Need to End the Stigma Around Mental Health

In March, three Huffington Post editors explained why 2016 was The Most Depressing Election Ever. By May, The Atlantic was offering advice on "How to Preserve Your Mental Health Despite the 2016 Election." Just weeks before the election, CNBC noted how election-initiated depression was affecting consumer behavior. And since the election, headlines have been dominated by reports of individuals experiencing paralyzing stress, anxiety, sadness, and fear. With so many feeling so bad, the question of how we collectively address emotional and mental health has taken center stage.

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New York City may have a model worth replicating. One year ago, New York City's Mayor Bill de Blasio and First Lady Chirlane McCray announced a citywide initiative close the gaps in mental health care provisions. ThriveNYC is now one year old, and this month launched an important new component, NYC-WELL, a mental health hotline that will cost the city $5 million annually. I sat down with McCray, a longtime mental health advocate, to discuss NYC-WELL and why it is worth the investment.

NYC-WELL is a core component of ThriveNYC, our city's comprehensive mental health roadmap. It is a crisis tool, but it is also about prevention and intervention.

People tend to think of a hotline as something to call on the brink of suicide or in the midst of a crisis. NYC-WELL can be used for that purpose, but it is much more. We want to help people develop coping mechanisms and connect them with providers for developing long-term solutions for whatever they are facing.

Sometimes when people call in, they don't even really know how to assess what they're going through. They don't know if it's something that requires a therapist, or a social worker, or a psychiatrist, or something else. We ensure they have a trained counselor at the other end of the line to help them figure it out and to help them to connect them with the appropriate provider.

This is a very different way of using a call-in tool. What lead to this innovation?

We are guided by evidence and experience. Research tells us early action creates the best outcomes. It is also tells us mental illness and substance abuse are distressingly common. One in five New Yorkers experience mental distress each year. Every time I speak to large groups I ask the people to, "Raise a hand if no one in your family, or you personally, have never experienced mental illness or substance abuse." There is never a hand in the air. Never. That makes it more than a statistic, for me. It means every family is affected.

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When my own daughter was diagnosed with anxiety and depression, we were shocked and lost about what to do next.

My family is no exception. When my own daughter was diagnosed with anxiety and depression, we were shocked and lost about what to do next. We were talking to doctors and professionals who were using a lot terminology that was very new to us. These were good people, but were they the right people for our daughter? Even with all of our resources, it was hard—really hard. I could not possibly imagine how anyone could navigate this experience without help. That was when it became very clear to me—we have mental health care providers, but we don't have a true mental health system. We pay a lot of attention to physical fitness, but we invest very little in mental and emotional wellness. That must change.

Chirlane McCray and Bill de Blasio with their children

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One of the stated goals of ThriveNYC is to change the culture surrounding mental illness. How does NYC-WELL help to do this?

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We want to help everyone understand it is real people with real faces and real stories who suffer from addiction and anxiety and depression and other challenges. People with mental illnesses also go to work, and school, and worship, and have relationships. The counselors do a great job, especially the peer counselors who often speak from their own experiences. They can say, "You know what? I went through this. I understand. This is what I did. It may not be right for you, but this is what I did. This is what helped me to get through it."

Right now many people may not have an official diagnosis, but they are feeling depressed, anxious, and stressed. The long and divisive election and the surprising outcome left many Americans with a heightened sense of distress. But isn't stress and fear a perfectly reasonable, even healthy, reaction to the world right now? I am more worried about the mental health of people who feel no anxiety! How does NYC-WELL address—let's call it—socially appropriate emotional distress?

We need a framework of trauma and resilience. Yes, we will face traumas that are real. Some trauma may be imposed by political, economic, and social changes. Some people will be more vulnerable to trauma—members of LGBT communities, black communities, immigrant communities, and poor communities may have more triggers and vulnerabilities than people who are better insulated from these big social traumas. Even within these communities, there are people better able to overcome obstacles and scale the barriers. That is the resilience factor. That is where we can help. We can help people learn to be more resilient in a variety of ways.

How do we help people build individual and community resilience?

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The holidays are a time when many people can really sink into a funk, so in NYC, we have focused on publicizing this service. We have people in barbershops, beauty salons, and going door-to-door in high-need communities. We have counselors and advertisements and translation in more than 200 languages. We are partnering with faith communities. We are working with more than 1,000 churches, synagogues, mosques, and temples in the city to give them tool kits to facilitate conversation with their congregations about mental illness and substance abuse. Clergy members are first responders because people quite often trust them and go to them

Part of that training is what we call Mental Health First Aid, but it is more like mental health CPR because what you learn can truly save lives. It teaches you what to do if someone is thinking or talking about suicide. Just like with physical first aid, you learn how to intervene to save someone.

One thing is certain; we must stop using the criminal justice system as a mental health care system.

There is one group of first responders we have not discussed—police officers. The NYC-WELL website still directs people in an emergency situation to call 9-1-1. However, we know when individuals call 9-1-1 seeking help for their loved ones in a mental health crisis, they have sometimes experienced a far worse trauma when police officers arrived on the scene and harmed or killed the very person they were called to help. Does NYC-WELL seek to change the culture of policing as well?

If someone is actively in crisis, then 9-1-1 is still the number to call. Ideally we want to have all of our officers trained to be able to deal with individuals with mental illness so these tragedies don't occur. But in the meantime, I think we don't give our officers enough credit. We tend to focus only on the negative encounters and not on the thousands of encounters that are resolved well. I would invite critics to do a deep dive into understanding the very sophisticated ways our officers currently deal with these scenarios. … Finally, let me say, NYPD officers truly welcome additional training. They want to know how to better address the needs of members of the community suffering with mental illness. It helps them to do their job and they welcome it.

One thing is certain; we must stop using the criminal justice system as a mental health care system. Far too many people end up incarcerated who should never be in jail at all. They are suffering, and when they go to jail they just suffer more trauma. The cycle continues. If we can get the right treatment early, we can interrupt that cycle and make sure people who should never have been in jail never end up there. Let's make sure people get the right treatment when they need it.

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